LE3 Abdomen 2024 Flashcards
- The cecum is considered dilated when its diameter exceeds ___ cm.
A. 3
B. 6
C. 9
D. 12
C. 9 cm
The cecum is considered dilated when its diameter exceeds 9 cm on radiographic imaging. This criterion is important to assess potential colonic obstruction or other related conditions. A dilated cecum is an indication of abnormal distension, which may suggest underlying issues like obstruction, volvulus, or pseudo-obstruction. The larger the cecal diameter, the higher the risk of colonic perforation, particularly when it reaches critical values beyond 12-15 cm.
- The “string of pearls” sign represents air within the __________.
A. Plicae circulares
B. Plicae semilunaris
C. Bowel wall
D. Beaded biliary tree
A. Plicae circulares
The “string of pearls” sign refers to the presence of gas bubbles trapped between the plicae circulares in the small intestine, as seen on an upright abdominal radiograph or CT scan. This sign is indicative of small bowel obstruction (SBO). The plicae circulares are numerous mucosal folds within the small intestine, helping with nutrient absorption by increasing surface area. The presence of the “string of pearls” is often due to the accumulation of gas and fluid above the site of obstruction, typically found in the early stages of small bowel obstruction when the bowel is hyperactive.
- A precursor to appendiceal perforation, characterized by focal wall non-enhancement on CT scan representing necrosis, is known as:
A. Gangrenous appendicitis
B. Acute appendicitis with obstructing appendicoliths
C. Periappendiceal abscess
D. Appendiceal mucocele
A. Gangrenous appendicitis
Focal wall non-enhancement on a CT scan of the appendix is characteristic of gangrenous appendicitis, a severe form of appendicitis that precedes perforation. This occurs due to compromised blood flow, leading to necrosis of the appendiceal wall. Gangrenous appendicitis presents with increased severity compared to uncomplicated acute appendicitis and requires prompt surgical intervention to prevent further complications, such as abscess formation or generalized peritonitis.
- The characteristic radiographic feature of diffuse esophageal spasm on a barium swallow is:
A. Foreshortening and stricturing of the distal esophagus (e.g., hiatal hernia, short esophagus)
B. Rat-tail deformity of the distal esophagus (e.g., Achalasia)
C. Corkscrew appearance of the esophagus
D. Multiple out-pouchings or pseudodiverticula (e.g., Crohn’s disease)
C. Corkscrew appearance of the esophagus
The characteristic radiographic feature of diffuse esophageal spasm on a barium swallow is the corkscrew appearance. This results from simultaneous, non-peristaltic contractions throughout the esophagus, leading to multiple contractions visible on a barium swallow. This condition is a motility disorder that can cause chest pain and dysphagia, which can mimic other conditions like angina. The “corkscrew” or “rosary bead” appearance reflects the spastic contractions, differing from other esophageal conditions like achalasia, which show the “bird-beak” or “rat-tail” deformity.
- A contrast-enhanced CT scan of the abdomen reveals a sharply-defined, water-density lesion in the left hepatic lobe, with no perceptible wall and no contrast enhancement. The primary consideration is:
A. Cavernous hemangioma
B. Primary hepatocellular carcinoma
C. Metastasis from pancreatic carcinoma
D. Hepatic cyst
D. Hepatic cyst
A sharply-defined, water-density lesion in the liver without a perceptible wall or contrast enhancement on a contrast-enhanced CT scan suggests a hepatic cyst. Hepatic cysts are usually benign and asymptomatic, often discovered incidentally during imaging for other conditions. They contain fluid and lack internal septations, calcifications, or enhancement, differentiating them from other lesions like hemangiomas, metastases, or hepatocellular carcinoma.
- The most common site of gastrointestinal tuberculosis is:
A. Sigmoid colon
B. Stomach
C. Ileocecal segment
D. Duodenum
C. Ileocecal segment
The ileocecal segment is the most common site of gastrointestinal tuberculosis (GI TB). Tuberculosis in this region typically affects the terminal ileum, cecum, and proximal ascending colon. The reasons for this preference include the high absorptive surface area, a longer transit time, and a higher rate of lymphoid tissue in this area. The ileocecal TB presents with symptoms like right lower quadrant pain, fever, weight loss, and can mimic other conditions like Crohn’s disease or appendicitis.
- Compensatory hypertrophy of the opposite kidney is often seen in which congenital renal anomaly?
A. Renal agenesis
B. Horseshoe kidney
C. Von Hippel-Lindau disease
D. Cross-fused renal ectopia
A. Renal agenesis
Renal agenesis is a congenital condition where one kidney fails to develop, often leading to compensatory hypertrophy of the remaining kidney. This is the body’s way of compensating for the missing renal function, where the contralateral kidney increases in size to meet the metabolic demands. Renal agenesis can occur unilaterally or bilaterally, with the latter being incompatible with life.
- This structure divides the gastrointestinal system into upper and lower portions:
A. Ampulla of Vater
B. Ileocecal valve
C. Ligament of Treitz
D. Ligamentum teres
C. Ligament of Treitz
The Ligament of Treitz is the anatomical structure that divides the gastrointestinal tract into upper and lower portions. It is located at the duodenojejunal junction and is significant in clinical settings for determining the source of gastrointestinal bleeding, with bleeding proximal to the ligament classified as upper GI bleeding and bleeding distal to it classified as lower GI bleeding. This distinction aids in guiding appropriate diagnostic and therapeutic interventions.
- What is the most likely diagnosis given the CT scan findings of diffuse hydronephrosis, a complex renal mass, and the presence of a staghorn calculus?
A. Autosomal dominant polycystic kidney disease
B. Renal metastasis
C. Perirenal abscess
D. Xanthogranulomatous pyelonephritis
D. Xanthogranulomatous pyelonephritis
The most likely diagnosis given the CT findings of diffuse hydronephrosis, a complex renal mass, and a staghorn calculus is Xanthogranulomatous pyelonephritis (XGP). XGP is a rare, chronic inflammatory condition of the kidney that often results from chronic obstruction and infection, commonly associated with staghorn calculi. Imaging findings include an enlarged kidney, hydronephrosis, renal calculi, and a complex mass that may mimic a renal tumor. The treatment usually involves antibiotics and surgical removal of the affected kidney (nephrectomy).
- What is the hallmark of mechanical bowel obstruction?
A. Diffuse symmetrical dilatation of small and large bowel loops
B. Few air-fluid levels in some non-dilated small intestinal segments
C. Presence of pre-sacral or rectal gas
D. Transition point between dilated and non-dilated bowel
D. Transition point between dilated and non-dilated bowel
The hallmark of mechanical bowel obstruction is the transition point between dilated and non-dilated bowel on imaging, such as an abdominal X-ray or CT scan. In mechanical obstruction, the bowel proximal to the obstruction becomes dilated due to the buildup of gas and fluid, while the distal bowel remains collapsed. Identifying this transition helps to locate the level of obstruction, which is important for determining treatment, whether surgical intervention or conservative
- What screening methods are appropriate for patients with abdominal pain?
A. CT scan
B. MRI
C. Ultrasound
D. X-ray
D. X-ray
Abdominal X-rays are commonly used as an initial screening tool to evaluate patients presenting with abdominal pain. They can help identify a variety of conditions, including masses, perforations (holes in the intestine), and obstructions. An abdominal X-ray is a quick, inexpensive, and non-invasive method that can provide valuable information about the presence of gas patterns, air-fluid levels, or free air, which could indicate conditions such as bowel obstruction, volvulus, or pneumoperitoneum. In cases of suspected bowel perforation, an upright abdominal or chest X-ray can help detect free air under the diaphragm, which is a hallmark of this condition.
- A chronic inflammatory bowel disease where the affected bowel becomes featureless with loss of the normal haustral markings (lead pipe sign) is:
A. Ulcerative colitis
B. Crohn’s disease
C. Diverticulitis
D. Appendicitis
A. Ulcerative colitis
The lead pipe sign refers to a featureless colon with the loss of haustral markings, commonly seen in Ulcerative colitis (UC) on barium studies or CT. UC is a chronic inflammatory bowel disease that involves continuous inflammation of the colon, leading to a “lead pipe” appearance due to the chronic loss of haustrations and mucosal architectural distortion. This condition primarily affects the mucosal layer of the colon, beginning in the rectum and extending proximally in a continuous pattern. Unlike Crohn’s disease, which has patchy involvement, UC affects the colon in a more uniform manner.
- What is the radiologic diagnosis based on the provided symptoms?
A. Pneumoperitoneum
B. Pneumobilia
C. Gut obstruction
D. Generalized ileus
A. Pneumoperitoneum
The radiologic diagnosis in the provided X-ray image is Pneumoperitoneum, which is characterized by the presence of free air within the peritoneal cavity. This condition is a medical emergency often indicating a perforation of a hollow abdominal organ, such as a perforated gastric or duodenal ulcer, that allows gas to escape into the abdominal cavity.
In the image, several signs that are consistent with pneumoperitoneum can be identified:
- Double wall sign (Rigler’s sign): This occurs when air is present on both sides of the intestinal wall, making the walls of the bowel clearly visible. This sign is indicative of free intraperitoneal air.
- Football sign: Seen in massive pneumoperitoneum, the outline of the abdomen resembles an American football due to the large amount of free air within the peritoneal cavity.
- Cupola sign: The accumulation of air beneath the diaphragm, particularly visible on an upright X-ray.
These signs are suggestive of the presence of free gas in the abdominal cavity and indicate an urgent need for surgical intervention to address the source of the perforation and prevent peritonitis and sepsis. The condition requires immediate medical evaluation, and in most cases, surgical repair of the perforation is indicated.
- Which of the following is associated with Von Hippel-Lindau Disease?
A. Intracranial aneurysm
B. Mitral valve prolapse
C. Renal cell carcinoma
D. Xanthogranulomatous pyelonephritis
C. Renal cell carcinoma
Von Hippel-Lindau Disease (VHL) is associated with the development of several types of tumors, including Renal cell carcinoma (RCC), pheochromocytomas, and hemangioblastomas of the brain and retina. RCC in VHL patients often presents bilaterally, and patients are at an increased risk for developing multifocal tumors. Regular imaging surveillance is recommended for early detection and treatment of RCC and other VHL-associated tumors.
- Hepatomegaly is suspected on ultrasound based on which of the following findings?
A. Increased parenchymal echogenicity greater than the right kidney
B. Extension of the liver edge above the right kidney
C. Markedly sharpened inferior border of the right lobe
D. Liver span of 20 cm
D. Liver span of 20 cm
Hepatomegaly refers to the enlargement of the liver, which can be suspected on ultrasound when the liver span exceeds 20 cm. Hepatomegaly can have several causes, such as fatty liver disease, congestive heart failure, cirrhosis, or malignancy. On ultrasound, hepatomegaly can be further characterized by changes in echotexture, such as increased echogenicity (suggestive of fatty liver) or the presence of focal lesions.
- A radiograph of a patient with known peptic ulcer disease (PUD) who presents to the ER with severe abdominal pain and increasing abdominal girth shows a markedly dilated air-filled stomach nearly occupying the entire abdominal cavity. What is the radiologic diagnosis?
A. Gastric outlet obstruction
B. Small gut obstruction
C. Lower GI obstruction
D. Perforated gastric ulcer
A. Gastric outlet obstruction
The presence of a markedly dilated air-filled stomach occupying the entire abdominal cavity on imaging, especially in a patient with known peptic ulcer disease (PUD), is consistent with gastric outlet obstruction. This occurs when there is an obstruction at the level of the pylorus or duodenum, leading to impaired gastric emptying. Causes include chronic scarring from ulcers, tumors, or other masses obstructing the pyloric canal. Symptoms include severe abdominal pain, vomiting, and bloating.
- Which of the following findings in renal cell carcinoma is predictive of tumor spread?
A. Heterogeneous enhancement of the renal mass, less than that of the renal parenchyma
B. Low-density areas within the tumor
C. Perirenal fat stranding
D. Soft tissue nodules in the perinephric fat
D. Soft tissue nodules in the perinephric fat
The presence of soft tissue nodules in the perinephric fat on imaging is predictive of tumor spread in patients with renal cell carcinoma (RCC). RCC is known to spread via direct invasion, hematogenous routes, or lymphatic channels, and involvement of the perinephric fat indicates a more advanced stage of the disease. This finding can help guide treatment decisions, such as surgical resection versus systemic therapy.
- What does the presence of free air within the peritoneal cavity indicate?
A. Pneumothorax
B. Rigler sign
C. Pneumoperitoneum
D. Pneumobilia
C. Pneumoperitoneum
The presence of free air within the peritoneal cavity is known as Pneumoperitoneum. It is often a sign of a perforated abdominal viscus, such as a perforated peptic ulcer, and is considered a surgical emergency. The presence of free intraperitoneal air can be detected on imaging studies like an upright chest or abdominal X-ray, where air under the diaphragm is characteristic. Prompt surgical intervention is needed to repair the perforation and manage the risk of peritonitis.
- A solitary, peripherally located abscess in the right hepatic lobe is most likely:
A. Amoebic
B. Echinococcal
C. Fungal
A. Amoebic
A solitary, peripherally located abscess in the right hepatic lobe is most likely amoebic. Amoebic liver abscesses are caused by Entamoeba histolytica, which reaches the liver via the portal vein. They are commonly solitary and predominantly found in the right hepatic lobe. Clinically, symptoms are similar to those of pyogenic abscesses, including fever, right upper quadrant pain, and tender hepatomegaly. On imaging, amoebic abscesses can be hypoechoic or anechoic, often with indistinct margins.
- A routine abdominal ultrasound in a 29-year-old female reveals a round, well-defined, homogeneous hyperechoic lesion in the right lobe of the liver, which on CT shows nodular peripheral enhancement with gradual pooling. The primary consideration is:
A. Cavernous hemangioma
B. Hepatocellular carcinoma
C. Metastasis
D. Hepatic cyst
A. Cavernous hemangioma
A round, well-defined, homogeneous hyperechoic lesion in the liver with nodular peripheral enhancement and gradual pooling on CT is consistent with a cavernous hemangioma. This benign vascular tumor is the most common liver lesion, and its appearance is characteristic on imaging. On ultrasound, it appears hyperechoic with posterior acoustic enhancement. The CT findings of peripheral nodular enhancement with centripetal filling in are pathognomonic of hemangiomas.
- One of the CT findings indicative of unresectability of pancreatic adenocarcinoma is:
A. Extension to the duodenum
B. Lung metastasis
C. Tumor necrosis
D. Vascular encasement
D. Vascular encasement
One of the CT findings indicative of unresectability of pancreatic adenocarcinoma is vascular encasement. When the tumor encases surrounding arteries (e.g., celiac axis, superior mesenteric artery), surgical resection becomes impossible. Other findings of unresectability include distant metastasis, ascites, and lymph node involvement beyond the surgical field.
- One of the characteristic features of fatty infiltration of the liver is:
A. Bulging liver contour
B. Displacement of the intrahepatic blood vessels
C. Increased parenchymal echogenicity on ultrasound
D. Liver density greater than that of the spleen on non-enhanced CT
C. Increased parenchymal echogenicity on ultrasound
One of the characteristic features of fatty infiltration of the liver is increased parenchymal echogenicity on ultrasound. Fatty liver disease is characterized by increased fat deposition within hepatocytes, resulting in a brighter liver compared to the adjacent kidney cortex on ultrasound. Other features may include hepatomegaly, and in advanced cases, poor visualization of the hepatic vessels.
- The most common form of gastritis is:
A. Alkali gastritis
B. Emphysematous gastritis
C. H. pylori gastritis
D. Phlegmonous gastritis
C. H. pylori gastritis
The most common form of gastritis is H. pylori gastritis. Helicobacter pylori is a bacterium that colonizes the stomach lining, leading to chronic inflammation, peptic ulcer disease, and, in some cases, gastric cancer. Diagnosis can be made through non-invasive testing such as urea breath tests or stool antigen tests, or via endoscopy with biopsy. Eradication therapy typically involves a combination of antibiotics and proton pump inhibitors.
- The radiographic sign of a malignant gastric ulcer is:
A. Carman meniscus sign
B. Ulcer collar
C. Telltale triangle sign
D. Hampton’s line
A. Carman meniscus sign
The Carman meniscus sign is a radiographic feature of a malignant gastric ulcer. This sign is observed when there is a lenticular-shaped filling defect of barium with the inner margin convex toward the gastric lumen, typically indicating a large ulcerated neoplasm. The meniscus shape suggests thickened, irregular edges, consistent with malignancy.
- The radiographic sign suspicious for sigmoid volvulus is:
A. Northern exposure sign
B. Frimann-Dahl sign
C. Liver overlap sign
D. Coffee bean sign
D. Coffee bean sign
The coffee bean sign is a radiographic feature that is highly suspicious for sigmoid volvulus. It represents the appearance of the twisted loop of sigmoid colon, which takes on the shape of a coffee bean due to the distention of bowel loops filled with gas. Sigmoid volvulus is a condition where the sigmoid colon twists around its mesentery, leading to obstruction and potential bowel ischemia.
- A 44-year-old male patient, an alcoholic with a history of severe epigastric pain and elevated serum amylase, shows an encapsulated collection of fluid and debris in the area of the pancreatic body and tail on CT scan. The most likely diagnosis is:
A. Pancreatic carcinoma
B. Phlegmon
C. Portal and splenic vein thrombosis
D. Pseudocyst
D. Pseudocyst
The encapsulated collection of fluid and debris seen on CT scan in a patient with a history of severe pancreatitis is most likely a pancreatic pseudocyst. Pseudocysts are common complications of acute pancreatitis and contain pancreatic enzymes, necrotic tissue, and fluid. They are not true cysts as they lack an epithelial lining. Management depends on the size and symptoms, with some requiring drainage.
- Which of the following is an example of closed-loop obstruction?
A. Post-surgical adhesions
B. Reducible intestinal hernia
C. Volvulus
D. Ulcerative colitis
C. Volvulus
A volvulus is an example of a closed-loop obstruction, occurring when a segment of bowel twists on itself and its mesentery, leading to a segment of bowel that is obstructed at two points. This creates a closed-loop obstruction, which is a surgical emergency due to the risk of strangulation and bowel necrosis. Symptoms include sudden, severe abdominal pain, vomiting, and signs of bowel obstruction.
- The arterial supply of the small bowel is primarily provided by:
A. Celiac artery
B. Inferior mesenteric artery
C. Superior mesenteric artery
D. Vasa recta and tributaries
C. Superior mesenteric artery
The arterial supply of the small bowel is primarily provided by the superior mesenteric artery (SMA). The SMA arises from the abdominal aorta and supplies the entire small intestine, except for parts of the duodenum, and also provides blood flow to the ascending colon and part of the transverse colon. The celiac artery supplies the stomach, liver, and spleen, while the inferior mesenteric artery supplies the distal colon and rectum. The vasa recta are smaller vessels branching from the SMA to supply the intestines.
- This anatomic feature that distinguishes the small bowel from the large bowel is:
A. Haustration
B. Plicae semicircularis
C. Taenia coli
D. Valvulae conniventes
D. Valvulae conniventes
Rationale:
The valvulae conniventes, also known as plicae circulares, are folds in the mucosa of the small intestine that are continuous across the lumen, distinguishing the small bowel from the large bowel. In contrast, the large bowel has haustra, taenia coli, and lacks continuous folds like the valvulae conniventes.
- A 52-year-old male suffering from chronic constipation shows an “apple-core” deformity on barium enema. Which segment of the colon is most commonly involved in cases of carcinoma?
A. Ascending colon
B. Descending colon
C. Sigmoid colon
D. Transverse colon
C. Sigmoid colon
Rationale:
The sigmoid colon is the most common site for colorectal carcinoma, often presenting with symptoms like chronic constipation, altered bowel habits, and, in this case, the classic “apple-core” deformity on barium enema, indicative of a stenosing lesion caused by the tumor.
- The ultrasound sign indicative of renal parenchymal disease is:
A. Diffuse increase in parenchymal echogenicity
B. Dilatation of the renal pelvocalyces and ureter
C. Parenchymal destruction and cavity formation
A. Diffuse increase in parenchymal echogenicity
Rationale:
An ultrasound finding of diffuse increased echogenicity of the renal parenchyma is indicative of renal parenchymal disease. This sign reflects chronic changes, such as scarring or fibrosis, within the kidney tissue, differentiating it from findings like dilatation of the renal pelvocalyces (seen in obstruction) or cavity formation (suggestive of abscess or advanced infection).
- Identify:
A. Gut obstruction
B. Generalized ileus
C. Normal bowel pattern
D. Sigmoid volvulus
Answer: A. Gut obstruction
The provided X-ray image demonstrates findings consistent with gut obstruction. The hallmark features seen in bowel obstruction on an abdominal X-ray include:
- Dilated bowel loops: The small intestine is visibly dilated, with air-fluid levels present, suggesting an obstructive process. The presence of multiple air-fluid levels is particularly characteristic of a small bowel obstruction.
- Step-ladder appearance: This appearance is due to the dilated loops of bowel stacked on top of each other.
The presence of dilated loops with air-fluid levels, as seen in the upright abdominal X-ray, indicates a mechanical obstruction of the bowel. Depending on the location and nature of the obstruction, the clinical management can involve conservative treatment, such as nasogastric decompression, or surgical intervention if there is a risk of strangulation or bowel perforation. It is essential to evaluate the patient clinically and correlate imaging findings with symptoms for appropriate management.
- What is the modality of choice to evaluate a teenager with acute scrotal pain?
A. X-ray
B. Ultrasound
C. CT
D. MRI
B. Ultrasound
The modality of choice to evaluate a teenager with acute scrotal pain is ultrasound, specifically Doppler ultrasound. This imaging modality is non-invasive, readily available, and provides information about blood flow, which is crucial for diagnosing conditions such as testicular torsion (which requires prompt intervention), epididymitis, or testicular trauma. Doppler ultrasonography can assess perfusion and help differentiate between these conditions.
- Forniceal rupture caused by high-grade obstruction coupled with high urine output will present on CT scan as:
A. Dilatation of the pelvicalyceal system
B. Increased attenuation of the affected kidney
C. Perinephric fluid collection
D. Tissue rim sign
C. Perinephric fluid collection
Forniceal rupture caused by high-grade obstruction coupled with high urine output will present on CT scan as a perinephric fluid collection. Forniceal rupture occurs when the increased pressure in the renal collecting system exceeds the threshold, causing a tear in the fornix of the renal calyx. This condition often results from an obstructive process, such as a kidney stone, that causes backpressure.
- Abrupt termination of the extrahepatic common bile duct seen on MRCP, with upstream dilatation of the intrahepatic ducts and an associated ill-defined mass at the porta hepatis, is most likely due to:
A. Cholecystolithiasis
B. Klatskin tumor
C. Mirizzi syndrome
D. Pancreatic head carcinoma
B. Klatskin tumor
Abrupt termination of the extrahepatic common bile duct with upstream dilatation of intrahepatic ducts and an associated mass at the porta hepatis is suggestive of a Klatskin tumor. Also known as perihilar cholangiocarcinoma, Klatskin tumors are located at the bifurcation of the right and left hepatic bile ducts and cause obstructive jaundice. Imaging findings typically include ductal dilatation with a mass near the hepatic hilum.
- “Small bowel feces” is a localizing sign for:
A. Appendicitis
B. Diverticulitis
C. Gut obstruction
D. Meckel’s diverticulum
C. Gut obstruction
The small bowel feces sign is a localizing sign for gut obstruction. It appears as particulate material resembling feces within a dilated segment of small bowel on CT imaging. This finding results from prolonged stasis, leading to mixing of gas, fluid, and particulate matter, and is usually indicative of a chronic or subacute obstruction.
- What is the most likely diagnosis in the presence of extensive retroperitoneal lymphadenopathy in a case with a homogeneous, round, poorly-enhancing renal mass?
A. Angiomyolipoma
B. Lymphoma
C. Xanthogranulomatous pyelonephritis
B. Lymphoma
The presence of extensive retroperitoneal lymphadenopathy with a homogeneous, round, poorly-enhancing renal mass is most likely due to lymphoma. The kidney is a common extranodal site of involvement for Non-Hodgkin lymphoma, which may present with poorly enhancing renal masses or retroperitoneal lymph nodes invading the kidneys. Primary renal lymphoma is rare, and involvement of the kidney often occurs as part of disseminated disease.
- The typical sign of intussusception seen in ultrasonography is:
A. Double-bubble sign
B. Coiled spring sign
C. Stierlin sign
D. Target sign
D. Target sign
The typical sign of intussusception seen on ultrasonography is the target sign. Intussusception occurs when one segment of bowel telescopes into another, leading to bowel obstruction and potentially ischemia. On ultrasound, it appears as concentric rings, giving a “target” or “doughnut” appearance in the transverse view. The gold standard for diagnosis and treatment is a contrast enema, which can also reduce the intussusception. The coiled spring sign may be seen on contrast studies, representing the intussusceptum prolapsing into the lumen.
- CT scan and ultrasound findings suspicious for acute appendicitis include:
A. Absence of appendicoliths
B. Avascularity on color flow Doppler
C. Clear periappendiceal fat planes
D. Appendiceal dilatation of more than 6 mm in diameter
D. Appendiceal dilatation of more than 6 mm in diameter
CT and ultrasound findings suspicious for acute appendicitis include an appendiceal diameter greater than 6 mm, wall thickening greater than 2 mm, adjacent mesenteric fat stranding, and possibly the presence of appendicolith. Other findings may include loss of the clear periappendiceal fat planes and avascularity on Doppler due to inflammation or necrosis. Ultrasound can be particularly useful in pediatric and pregnant patients to confirm the diagnosis.
- What is the ultrasound criteria for a simple renal cyst?
A. Bosniak 1
B. Homogeneous attenuation near-water density Hounsfield units
C. Option 3
D. Sharply defined far wall
D. Sharply defined far wall
The ultrasound criteria for a simple renal cyst include a sharply defined far wall, anechoic content (no internal echoes), and posterior acoustic enhancement. A simple renal cyst is benign, and its appearance on imaging should be homogenous with no septations, calcifications, or solid components.
- How can pneumoperitoneum be evaluated in patients who cannot tolerate upright films?
A. Prone position
B. Right lateral decubitus (right side down)
C. Left lateral decubitus (left side down)
D. Portable high sitting
C. Left lateral decubitus (left side down)
To evaluate for pneumoperitoneum in patients who cannot tolerate upright films, the left lateral decubitus position is useful. In this position, any free air will rise and be visible on the right side of the abdominal cavity, especially between the liver and abdominal wall. The left lateral decubitus film is helpful to detect even small amounts of free intraperitoneal air, providing an alternative to the upright radiograph.
- Necrotic cystic neoplasms or tumors that arise in the wall of a cyst are considered Bosniak Category:
A. 2
B. 3
C. 4
D. 5
C. 4
Bosniak Category 4 cysts are necrotic cystic neoplasms or tumors that arise within a cyst wall and have a high likelihood of being malignant. These cysts have enhancing soft tissue components or thick, irregular walls and septa. Management typically involves surgical intervention due to the risk of malignancy.
- In a 40-year-old female patient with one day of right upper quadrant abdominal pain and direct tenderness in the upper abdomen, along with a positive Murphy’s sign on physical examination, what is the initial imaging test that you will request?
A. CT scan of the abdomen
B. Endoscopy
C. Ultrasound of the abdomen
D. X-ray of the abdomen in supine and upright views
C. Ultrasound of the abdomen
The initial imaging test for a patient with right upper quadrant pain and a positive Murphy’s sign is ultrasound of the abdomen. Acute cholecystitis is suggested by the clinical findings, and ultrasound is the preferred imaging modality for evaluating gallbladder pathology. Findings may include gallstones, thickening of the gallbladder wall, pericholecystic fluid, and a positive sonographic Murphy’s sign.
- Presence of dysplastic dilatation of the collecting tubules in the renal papilla is diagnosed as:
A. Acquired uremic cystic kidney disease
B. Autosomal recessive polycystic kidney disease
C. Medullary sponge kidney
D. Tuberous sclerosis of the kidney
C. Medullary sponge kidney
Medullary sponge kidney is diagnosed by the presence of dysplastic dilatation of the collecting tubules in the renal papilla. This condition is characterized by cystic dilatation of the collecting ducts, which can lead to urinary stasis, stone formation, and sometimes recurrent urinary tract infections. Most patients are asymptomatic, and the kidneys often appear normal in size.
- What is the most common cause of small bowel obstruction in adults?
A. Adhesions
B. Neoplasm
C. Intussusception
D. Bowel ischemia
A. Adhesions
The most common cause of small bowel obstruction (SBO) in adults is adhesions, which are fibrous bands that form after previous abdominal surgeries, causing loops of bowel to adhere to each other or to the peritoneal wall. Adhesions can create kinks or twists, leading to obstruction. Other causes include hernias, neoplasms, or volvulus, but adhesions remain the predominant etiology, especially in patients with a surgical history.
- For suspected renal masses and tumors, the best imaging modality is:
A. KUB Ultrasound
B. Contrast-enhanced CT scan
C. Contrast-enhanced MRI
D. CT stonogram
B. Contrast-enhanced CT scan
The best imaging modality for suspected renal masses and tumors is a contrast-enhanced CT scan. CT provides detailed images of the renal parenchyma and can differentiate between benign and malignant lesions based on enhancement patterns. Contrast material helps highlight vascular structures and detect any abnormalities within the kidney.
- In ureteral duplication, based on the Weigert-Meyer rule:
A. The lower pole ureter drains inferior and medial to the normally placed ureter
B. The upper pole ureter passes through the bladder wall to insert abnormally
C. The lower pole ureter ends as ectopic ureterocele
D. The upper pole ureter is subject to vesicoureteral reflux
D. The upper pole ureter is subject to vesicoureteral reflux
In ureteral duplication, the Weigert-Meyer rule states that the upper pole ureter usually ends in an ectopic location and is prone to vesicoureteral reflux, while the lower pole ureter tends to drain normally but may be associated with ureterocele. In complete ureteral duplication, the upper moiety ureter is more likely to insert ectopically and have an abnormal course, leading to functional impairment and a risk of reflux.
- Cholelithiasis on imaging will present as:
A. Air in the biliary tract on radiographs
B. Echogenic shadowing foci on ultrasound
C. Hypodense lesions on CT scan
D. Increased tracer uptake on nuclear scintigraphy
B. Echogenic shadowing foci on ultrasound
Cholelithiasis, or gallstones, typically appears as echogenic shadowing foci on ultrasound. The stones produce acoustic shadowing because they are dense structures that block the passage of ultrasound waves, creating a characteristic shadow behind the stone. Ultrasound is the preferred imaging modality for diagnosing cholelithiasis, as it is non-invasive and highly sensitive for detecting gallstones.
- The most specific sign of strangulated bowel on contrast CT scan is:
A. Circumferential wall thickening of more than 3 mm
B. Edema of the bowel wall
C. Lack of enhancement of the bowel wall
D. Mesenteric haziness
C. Lack of enhancement of the bowel wall
The most specific sign of strangulated bowel on a contrast CT scan is the lack of enhancement of the bowel wall. Strangulation occurs when the blood supply to a segment of the bowel is compromised, leading to ischemia and necrosis. On CT imaging, a non-enhancing bowel wall indicates that there is no blood flow, suggesting ischemia. Other findings like circumferential wall thickening and edema can be seen in both strangulated and non-strangulated bowel obstructions, but lack of enhancement is more specific for ischemia.
- Presence of renal parenchymal destruction, cavity formation, scarring, and strictures are seen in:
A. Chronic pyelonephritis with reflux nephropathy
B. Emphysematous pyelonephritis
C. Renal tuberculosis
D. Xanthogranulomatous pyelonephritis
C. Renal tuberculosis
Renal tuberculosis is characterized by renal parenchymal destruction, cavity formation, scarring, and strictures. It occurs as a result of hematogenous spread from a primary pulmonary tuberculosis infection. The disease often leads to granulomatous masses, fibrosis, and strictures within the collecting system, resulting in cavitation, calcification, and eventual scarring of the renal parenchyma. These changes can lead to obstruction of the urinary tract and progressive renal damage.
The findings of parenchymal destruction, granuloma formation, and calcifications are hallmarks of renal tuberculosis. This condition is diagnosed based on imaging studies and confirmed by microbiological testing, such as urine cultures for Mycobacterium tuberculosis.
- Intrarenal reflux with damage to the renal papilla, resulting in calyceal blunting and cortical scarring, is seen in:
A. Chronic pyelonephritis with reflux nephropathy
B. Emphysematous pyelonephritis
C. Renal tuberculosis
D. Xanthogranulomatous pyelonephritis
A. Chronic pyelonephritis with reflux nephropathy
Intrarenal reflux leading to damage to the renal papilla, calyceal blunting, and cortical scarring is seen in chronic pyelonephritis with reflux nephropathy. Reflux nephropathy is caused by VUR, in which urine flows back into the kidney, causing infections and chronic damage to the renal parenchyma. The scarring typically affects the upper and lower poles of the kidney and is associated with recurrent urinary tract infections.
- What is the clinical importance of evaluating the renal vein in cases of renal cell carcinoma?
A. Predicts metastasis to distant organs
B. Venous invasion is critical for surgical planning
B. Venous invasion is critical for surgical planning
Evaluating the renal vein in cases of renal cell carcinoma (RCC) is crucial because venous invasion affects surgical planning. RCC is known for its propensity to invade the renal vein and even extend into the inferior vena cava. The presence of venous involvement can influence the surgical approach, as more extensive resection may be required to remove the entire tumor and any thrombus within the veins.
- Which statement is true regarding malrotation with midgut volvulus?
A. The location of the cecum is normal in 80-90% of cases.
B. The double bubble sign may be seen on plain abdominal radiograph.
C. The cecum and right colon are seen in their normal anatomic position.
D. There is a long mesenteric attachment for the bowel.
B. The double bubble sign may be seen on plain abdominal radiograph
Malrotation with midgut volvulus can present with the double bubble sign on plain abdominal radiographs. This sign indicates two air-filled structures—the stomach and the proximal duodenum—suggesting an obstruction. Malrotation is a congenital anomaly where the intestines do not rotate properly during fetal development, leading to an abnormal position of the bowel and an increased risk of volvulus, which is a surgical emergency.
- The most common filling defect in the urinary tract on urography is:
A. Blood clot
B. Calculi
C. Transitional cell carcinoma
D. Tuberculosis
B. Calculi
Calculi are the most common filling defect in the urinary tract on urography. Ureteral calculi (stones) appear as defects in the contrast column during intravenous urography. Other causes of filling defects include blood clots, transitional cell carcinoma, or tuberculosis, but calculi are by far the most common cause of obstruction and filling defects seen in the ureters.
- Hepatic metastasis is suspected in which enhancement pattern on CT scan?
A. Nodular peripheral enhancement with gradual filling in
B. Early arterial enhancement with rapid wash-out
C. “Target-like” enhancement
D. Significant wash-out in the delayed images
C. “Target-like” enhancement
Hepatic metastasis often shows a “target-like” enhancement pattern on CT imaging. This pattern is characterized by a central area of hypoattenuation surrounded by a rim of peripheral enhancement. The target-like appearance is indicative of the characteristic growth pattern of metastatic tumors, especially on contrast-enhanced scans.
- The most common associated abnormality in autosomal dominant polycystic kidney disease is:
A. Pancreatic cyst
B. Hepatic cyst
C. Aortic dissection
B. Hepatic cyst
The most common associated abnormality in autosomal dominant polycystic kidney disease (ADPKD) is a hepatic cyst. Hepatic cysts occur in over half of patients with ADPKD and are usually asymptomatic. Aortic dissection can also occur in ADPKD patients due to associated vascular abnormalities, but hepatic cysts are more common.
- What is the recommended initial screening imaging for hydronephrosis?
A. Ultrasound
B. MDCT
C. Nuclear renogram
D. MRI
A. Ultrasound
The recommended initial screening imaging for hydronephrosis is ultrasound. Ultrasound is non-invasive, inexpensive, and effective at detecting dilation of the renal pelvis and calyces, which is characteristic of hydronephrosis. Ultrasound can also help identify the cause of obstruction, such as a ureteral stone, and assess renal parenchymal thickness.
- Pneumatosis is defined as air in the:
A. Bowel lumen
B. Intestinal wall
C. Peritoneal cavity
D. Solid organs
B. Intestinal wall
Pneumatosis refers to the presence of air within the intestinal wall. Pneumatosis intestinalis can be associated with several conditions, including bowel ischemia, necrotizing enterocolitis, or trauma. The presence of air in the bowel wall is a concerning finding and may indicate a compromised bowel that requires urgent medical or surgical intervention.
- What is the difference between pneumobilia and portal venous gas?
A. Pneumobilia is peripheral in location.
B. Portal venous gas is peripheral in location.
C. Pneumobilia is an ominous sign of ischemic bowel.
D. Portal venous gas is common in post-cholecystectomy.
B. Portal venous gas is peripheral in location
Portal venous gas is typically peripheral in location, seen in the branches of the portal vein that extend to the periphery of the liver. It is an ominous sign often associated with small bowel infarction. Pneumobilia, on the other hand, is the presence of air in the biliary tree and is commonly visualized in the anterior portion of the liver. Pneumobilia may be seen after procedures like endoscopic retrograde cholangiopancreatography (ERCP) or in cases of biliary-enteric fistula, and it is not typically associated with bowel ischemia.
- Which of the following is a characteristic finding of schistosomiasis of the urinary bladder?
A. Bladder outlet obstruction
B. Calcification of the wall
C. Prolapse of the dilated distal ureter
D. Radiolucent halo produced by the wall of the ureter
B. Calcification of the wall
A characteristic finding of schistosomiasis of the urinary bladder is calcification of the wall. Schistosomiasis is a parasitic infection that leads to chronic inflammation and fibrosis, resulting in the calcification of the bladder wall. This can be seen on imaging as a “cobblestone” appearance, which is due to the calcified eggs embedded in the bladder wall.
- In transitional cell carcinoma, careful evaluation of the entire urinary tract is warranted for which reason?
A. Associated with drugs such as cyclophosphamide and phenacetin
B. Linked to smoking
C. Metastasizes to regional lymph nodes, liver, lung, and bones
D. Tendency to be multicentric
D. Tendency to be multicentric
In transitional cell carcinoma (TCC), careful evaluation of the entire urinary tract is warranted because of its tendency to be multicentric. TCC can occur simultaneously in multiple areas of the urinary tract, including the renal pelvis, ureters, and bladder, which makes complete imaging of the urinary tract important for accurate diagnosis and treatment planning. TCC is also linked to risk factors such as smoking and exposure to certain chemicals.
- What is the golden period during which 80% salvage of a testicle suspected of torsion can be achieved?
A. 6 hours
B. 2 hours
C. 12 hours
D. 24 hours
A. 6 hours
The golden period for achieving 80% salvage of a testicle suspected of torsion is within 6 hours of the onset of symptoms. Testicular torsion is a urological emergency, and early diagnosis and intervention are critical to preserving testicular function. Surgical detorsion and fixation (orchiopexy) are performed to prevent recurrence.
